Ch 37 Obstetrics & Care of the Newborn.pptx

EMT

1. Chapter 37 Obstetrics and Care of the Newborn Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care , Ninth Edition Joseph J. Mistovich • Keith J. Karren

2. Anatomy and Physiology of the Obstetric Patient

3. Anatomy of Pregnancy

4. Ovaries Fallopian tubes Uterus Cervix

5. Menstrual Cycle

6. Estrogen Progesterone 24–35 days Menstruation Ovulation Implantation Menopause

7. Prenatal Period

8. Pre-embryonic stage Embryonic stage Fetal stage Gestational age Full-term pregnancy Trimesters

9. Physiologic Changes in Pregnancy

10. Reproductive Respiratory Cardiovascular Gastrointestinal Urinary Musculoskeletal

11. Antepartum (Predelivery) Emergencies

12. Antepartum Conditions Causing Hemorrhage Spontaneous Abortion

13. Antepartum Conditions Causing Hemorrhage Ectopic Pregnancy

14. Pathophysiology Predisposing factors Assessment Emergency medical care Ectopic Pregnancies

15. Antepartum Conditions Causing Hemorrhage Placenta Previa

16. Pathophysiology Predisposing factors Assessment Emergency medical care Placenta Previa

17. Antepartum Conditions Causing Hemorrhage Abruptio Placentae

18. Pathophysiology Types Predisposing factors Assessment Emergency medical care Abruptio Placentae

19. Antepartum Conditions Causing Hemorrhage Ruptured Uterus

20. Pathophysiology Assessment Emergency medical care Ruptured Uterus

21. Antepartum Seizures and Blood Pressure Disturbances Seizures During Pregnancy

22. Seizures During Pregnancy Life threatening for mother and fetus Treat same as any seizure patient Protect from injury Transport on left side (>20 wks, >15∘) May be associated with eclampsia

23. Antepartum Seizures and Blood Pressure Disturbances Preeclampsia/Eclampsia

24. Preeclampsia/Eclampsia Pregnancy-induced hypertension (PIH) >140/90 q 6hrs Pathophysiology Assessment Emergency medical care

25. Antepartum Seizures and Blood Pressure Disturbances Supine Hypotensive Syndrome

26. Supine Hypotensive Syndrome Pathophysiology Assessment Emergency medical care >20 wks, >15’

27. Assessment-Based Approach: Antepartum (Predelivery) Emergency Scene Size Up

28. Scene Size-Up Obstetric emergency Any woman of childbearing age* could be experiencing an obstetric emergency * (generally 12-50)

29. Assessment-Based Approach: Antepartum (Predelivery) Emergency Primary Assessment

30. Primary Assessment Scene safety Mental status ABCs

31. Assessment-Based Approach: Antepartum (Predelivery) Emergency Secondary Assessment

32. Secondary Assessment SAMPLE and OPQRST History Gravida Para Signs and symptoms

33. OB Hx Questions ( AKA “Is birth about to happen?” and “Should I expect any complications?”)

34. DUE DATE NAME OF O.B. CROWNING, OR ANY PRESENTING PART CONTRACTIONS – FREQUENCY & DURATION FEELS NEED TO PUSH / HAVE BOWEL MOVEMENT

35. GRAVIDA (# times pregnant, incl. current pregnancy) PARA (# of live births) ABORTIONS (abortions or miscarriages) PRENATAL CARE

36. SMOKING/DRUGS/ ALCOHOL EXPECTED COMPLICATIONS W/ PREGNANCY COMPLICATIONS WITH PREV. PREGNANCIES TWINS/TRIPLETS/ MORE?

37. WATER BROKE? (R.O.M.) SPOTTING? MECONIUM? DISCHARGE? ANY ABD TRAUMA PREV BIRTHS VAGINAL OR CESAREAN

38. Assessment-Based Approach: Antepartum (Predelivery) Emergency Emergency Medical Care

39. Emergency Medical Care Ensure ABCs Care for vaginal bleeding Treat for shock Provide emergency medical care based on signs and symptoms Transport patient on her left side

40. Assessment-Based Approach: Antepartum (Predelivery) Emergency Reassessment

41. Reassessment Repeat primary assessment Repeat vital signs Check O 2

42. Labor And Normal Delivery

43. Labor First Stage: Dilation

44. First Stage Definition Duration Braxton Hicks contractions

45. Labor Second Stage: Expulsion

46. Second Stage: Expulsion Definition Duration < 2min frequency > 60-90 sec duration Signs and symptoms

47. Labor Third Stage: Placental

48. Third Stage: Placental Definition Duration Complications

49. Assessment-Based Approach: Active Labor and Normal Delivery Scene Size-Up, Primary Assessment, and Secondary Assessment

50. Scene Size-Up, Primary Assessment, and Secondary Assessment Transport or deliver on scene? Signs and symptoms Assist mother with delivery

51. Assessment-Based Approach: Active Labor and Normal Delivery Emergency Medical Care

52. Emergency Medical Care Position the patient Create a sterile field Monitor for vomiting Assess for crowning Apply gentle pressure to infant head as crowning Tear sac if not ruptured Watch for nuchal cord Suction fluid from infant’s airway

53. Emergency Medical Care Support newborn body as delivered Clean the newborn’s mouth and nose Dry, wrap, warm, and position the infant Assign your partner to monitor and care for infant Clamp and cut the umbilical cord (6” & 9”) Observe and transport delivery of the placenta Place pads over vaginal opening Record time of delivery Transport; keep mother and infant warm

54. Massaging the Uterus Position Massage technique Monitor

55. Assessment-Based Approach: Active Labor and Normal Delivery Reassessment

56. Reassessment Monitor for signs of shock Transport Massage uterus en route

57. Childbirth

58. Abnormal Delivery

59. Assessment-Based Approach: Active Labor with Abnormal Delivery Scene Size-Up, Primary Assessment, and Secondary Assessment

60. Scene Size-up, Primary Assessment, and Secondary Assessment Assess the same as a normal delivery Signs and symptoms Fetal presentation other than normal crowning Abnormal color or smell of amniotic fluid Labor before 38 weeks of pregnancy Recurrence of contractions after first infant is born

61. Assessment-Based Approach: Active Labor with Abnormal Delivery Emergency Medical Care and Reassessment

62. Emergency Medical Care Similar to that of normal delivery Emphasis on immediate transport, O 2 , and vital signs

63. Intrapartum Emergencies Prolapsed Cord

64. Prolapsed Cord

65. Intrapartum Emergencies Breech Birth

66. Breech Birth Definition Complication Position of mom Emergency medical care

67. Intrapartum Emergencies Limb Presentation

68. Limb Presentation Do not attempt a field delivery Transport immediately Emergency medical care

69. Intrapartum Emergencies Shoulder Dystocia

70. Shoulder Dystocia Definition “Turtle sign” Emergency medical care

71. Shoulder Dystocia

72. Intrapartum Emergencies Precipitous Delivery

73. Precipitous Delivery < 3 hrs labor Occurrence (multipara) Complications

74. Intrapartum Emergencies Multiple Births

75. Multiple Births Signs of multiple birth Emergency medical care When to transport GET MORE HANDS

76. Intrapartum Emergencies Meconium

77. Meconium Definition Complication Emergency medical care

78. Intrapartum Emergencies Preterm Labor

79. Preterm Labor Definition Complications Emergency medical care

80. Intrapartum Emergencies Premature Birth

81. Premature Birth Definition Appearance Emergency medical care

82. Intrapartum Emergencies Post-Term Pregnancy

83. Definition Complications in the uterus Complications to infant

84. Intrapartum Emergencies Premature Rupture of Membranes

85. Premature Rupture of Membranes Rupture of amniotic sac prior to onset of labor and before the end of the 37 th week Increased risk of infection and more difficult delivery

86. Postpartum Complications Postpartum Hemorrhage

87. Postpartum Hemorrhage Definition Causes Emergency medical care

88. Postpartum Complications Embolism

89. Embolism Occurrence Cause Signs and symptoms Emergency medical care

90. Care of the Newborn

91. Assessment-Based Approach: Care of the Newborn

92. Protect from heat loss Repeat suctioning

93. Assessment-Based Approach: Care of the Newborn Assessment

94. Assessment APGAR Appearance Pulse Grimace Activity Respirations

95. Signs and Symptoms Most require just the basics Signs of a severely depressed newborn

96. Assessment-Based Approach: Care of the Newborn Emergency Medical Care

97. Emergency Medical Care

98. The Moro Reflex The  Moro reflex  is an infantile reflex normally present in all infants/newborns up to 3 or 4 months of age as a response to a sudden loss of support, when the infant feels as if it is falling. It involves three distinct components: spreading out the arms (abduction) unspreading the arms (adduction) crying (usually)

99. And on Tuesday…

100. Videos https://www.youtube.com/watch?v=GE607p1Fw64 NORMAL CHILDBIRTH https://www.youtube.com/watch?v=851ybWmDbio APGAR TEST